Methodology of Ascertainment in Medical Malpractice in Living Persons

Chapter

Abstract

In recent decades, increasing significance has been placed on medical responsibility and liability. Progress in modern medicine has raised expectations that any health problem can be treated by specialists in any field of medicine. Nevertheless, depending on the circumstances and complications surrounding each particular case, a suspicion of medical malpractice can arise if the outcome is not as expected. The role played by legal medical experts has taken on increasing importance in judicial investigations. It is against this background that the first “Consensus Guidelines Document” dedicated to the evaluation process in cases of suspected medical malpractice was developed by the ECLM working group on medical malpractice in 2012. Once the qualification of the expert has been established as a prerequisite for the procedure, the methods of ascertainment can be determined. These include collecting all clinical data from the admission authorization to reports on post-surgical treatment and release from hospital. An analysis of the clinical documents may reveal a necessity to contact specialists of other fields to ensure a better definition of the case in question. A subsequent clinical examination is required to establish the clinical condition of the patient. Furthermore, the relationship between the current situation and previous medical actions must be verified. Other diagnostic procedures may be performed to ascertain the possibility of medical malpractice as a possible cause of impaired health. A clinical synthesis should summarize the main, central facts. The final evaluation begins with a comparison of data, followed by the identification of pathological features, damage or incapacities that constitute either temporary or permanent impairment, and the reconstruction of pathophysiological pathways. This evaluation should be based on scientific sources such as guidelines, consensus documents and established operational procedures. It may then be possible to determine real error, pseudo-error, conscious error or non-observance of required rules. This may also comprise a discussion of the direct relationship between error and damage, including the degree of probability of the relationship. All of these steps are described in detail in the ECLM consensus document. This can be seen as an example of harmonization of juridical-legislative medical malpractice procedures in European states.

References

  1. 1.
    Bruguera M, Arimany J, Bruguera R, Barberia E, Ferrer F, Sala J, Robinat AP, Muniz JM (2012) Guideline to prevent claims due to medical malpractice, on how to act when they do occur and how to defend oneself through the courts. Rev Clin Esp 212:198–205CrossRefPubMedGoogle Scholar
  2. 2.
    Dettmeyer R, Egl M, Madea B (2005) Medical malpractice charges in Germany–role of the forensic pathologist in the preliminary criminal proceeding. J Forensic Sci 50(2):423–427CrossRefPubMedGoogle Scholar
  3. 3.
    Ferrara SD, Baccino E, Bajanowski T, Boscolo-Berto R, Castellano M, De Angel R, Pauliukevičius A, Ricci P, Vanezis P, Vieira DN, Viel G, Villanueva E; EALM Working Group on Medical Malpractice (2013) Malpractice and medical liability. European Guidelines on Methods of ascertainment and criteria of evaluation. Int J Legal Med 127(3):545–557Google Scholar
  4. 4.
    Ferrara SD (2013) Medical malpractice and legal medicine. Int J Legal Med 127:541–543CrossRefPubMedGoogle Scholar
  5. 5.
    Oyebode F (2013) Clinical errors and medical negligence. Med Prin Pract 22:323–333CrossRefGoogle Scholar
  6. 6.
    Moreschi C, Da Broi U (2014) Clinical practice guidelines and medico legal issues in health care malpractice liability. Assist Inferm Ric 33:208–213PubMedGoogle Scholar
  7. 7.
    Svider PF, Eloy JA, Baredes S, Setzen M, Folbe AJ (2015) Expert witness testimony guidelines: identifying areas for improvement. Otolaryng Head Neck Surg 152:207–210CrossRefGoogle Scholar
  8. 8.
    Knaak J-P, Parzeller M (2014) Court decisions on medical malpractice. Int J Legal Med 128:1049–1057CrossRefPubMedGoogle Scholar
  9. 9.
    Vanezis P (2013) Medical responsibility and liability in the United Kingdom. In: Ferrara SD, Boscolo-Berto R, Viel G (eds) Malpractice and medical liability. Springer, Berlin Heidelberg, pp 129–413CrossRefGoogle Scholar
  10. 10.
    Ricci P, Ausania F, Arbarello P (2013) Medical responsibility and liability in Italy. In: Ferrara SD, Boscolo-Berto R, Viel G (eds) Malpractice and medical liability. Springer, Berlin Heidelberg, pp 209–226CrossRefGoogle Scholar
  11. 11.
    Baccino E (2013) Medical responsibility and liability in France. In: Ferrara SD, Boscolo-Berto R, Viel G (eds) Malpractice and medical liability. Springer, Berlin Heidelberg, pp 145–160CrossRefGoogle Scholar
  12. 12.
    Raposo VL, Viera DN (2013) Medical responsibility and liability in Portugal. In: Ferrara SD, Boscolo-Berto R, Viel G (eds) Malpractice and medical liability. Springer, Berlin Heidelberg, pp 189–207CrossRefGoogle Scholar
  13. 13.
    Pauliukevicius A, Caplinskiene M, Raudys R, Teteris O, Vabel G, Väli M (2013) Medical responsibility and liability in Lithuania, Latvia and Estonia. In: Ferrara SD, Boscolo-Berto R, Viel G (eds) Malpractice and medical liability. Springer, Berlin Heidelberg, pp 227–243CrossRefGoogle Scholar
  14. 14.
    Fischer G, Fetters MD, Munro AP, Goldman EB (1997) Adverse events in primary care identified from a risk-management database. J Fam Pract 45(1):40–46PubMedGoogle Scholar
  15. 15.
    Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, Howard KM, Weiler PC, Brennan TA (2000) Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 38(3):261–271CrossRefPubMedGoogle Scholar
  16. 16.
    Vincent C, Neale G, Woloshynowych M (2001) Adverse events in British hospitals: preliminary retrospective record review. BMJ 322(7285):517–519. Erratum in: BMJ 322(7299):1395Google Scholar
  17. 17.
    Ferrara SD, Baccino E, Boscolo-Berto R, Comandè G, Domenici R, Hernandez-Cueto C, Gulmen MK, Mendelson G, Montisci M, Norelli GA, Pinchi V, Ranavaya M, Shokry DA, Sterzik V, Vermylen Y, Vieira DN, Viel G, Zoja R; Members of the IALM Working Group on Personal Injury and Damage (2016) Padova Charter on personal injury and damage under civil-tort law: medico-legal guidelines on methods of ascertainment and criteria of evaluation. Int J Legal Med 130(1):1–12Google Scholar
  18. 18.
    Gómez-Durán EL, Martin-Fumadó C, Arimany-Manso J (2013) Legal medicine contributions to patient safety. From ascertainment and evaluation to research in medical liability. Int J Legal Med 127:1051–1053CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Institute of Legal Medicine, University of Duisburg-EssenUniversity Hospital EssenEssenGermany

Personalised recommendations